Provider Demographics
NPI:1346349255
Name:ODUM CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:ODUM CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. BRETT ODUM PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUM
Authorized Official - Suffix:
Authorized Official - Credentials:PLLC
Authorized Official - Phone:405-286-9977
Mailing Address - Street 1:1004 NW 150TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-286-9977
Mailing Address - Fax:405-286-9979
Practice Address - Street 1:1004 NW 150TH
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73013-0000
Practice Address - Country:US
Practice Address - Phone:405-286-9977
Practice Address - Fax:405-286-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty